History of Hospice Care | National Hospice and Palliative Care Organization National Hospice and Palliative Care Organization History of Hospice Care Hospice: A Historical Perspective The term “hospice” (from the same linguistic root as “hospitality”) can be traced back to medieval times when it referred to a place of shelter and rest for weary or ill travelers on a long journey. The name was first applied to specialized care for dying patients by physician Dame Cicely Saunders, who began her work with the terminally ill in 1948 and eventually went on to create the first modern hospice—St. Christopher’s Hospice—in a residential suburb of London. Saunders introduced the idea of specialized care for the dying to the United States during a 1963 visit with Yale University. Her lecture, given to medical students, nurses, social workers, and chaplains about the concept of holistic hospice care, included photos of terminally ill cancer patients and their families, showing the dramatic differences before and after the symptom control care. This lecture launched the following chain of events, which resulted in the development of hospice care as we know it today.

1965: Florence Wald, then Dean of the Yale School of Nursing, invites Saunders to become a visiting faculty member of the school for the spring term. 1967: Dame Cicely Saunders creates St. Christopher's Hospice in the United Kingdom. 1968: Wald takes a sabbatical from Yale to work at St. Christopher’s and learn all she can about hospice. 1969: A book based on more than 500 interviews with dying patients is published, entitled, On Death and Dying. Written by Dr. Elisabeth Kubler-Ross, it identifies the five stages through which many terminally ill patients progress. The book becomes an internationally known best seller. Within it, Kubler-Ross makes a plea for home care as opposed to treatment in an institutional setting and argues that patients should have a choice and the ability to participate in the decisions that affect their destiny. 1972: Kubler-Ross testifies at the first national hearings on the subject of death with dignity, which are conducted by the U.S. Senate Special Committee on Aging. In her testimony, Kubler-Ross states, “We live in a very particular death-denying society.

We isolate both the dying and the old, and it serves a purpose. They are reminders of our own mortality. We should not institutionalize people. We can give families more help with home care and visiting nurses, giving the families and the patients the spiritual, emotional, and financial help in order to facilitate the final care at home.” 1974: Florence Wald, along with two pediatricians and a chaplain, founded Connecticut Hospice in Branford, Connecticut. 1974: The first hospice legislation is introduced by Senators Frank Church and Frank E. Moss to provide federal funds for hospice programs. The legislation is not enacted. 1978: A U.S. Department of Health, Education, and Welfare task force reports that “the hospice movement as a concept for the care of the terminally ill and their families is a viable concept and one which holds out a means of providing more humane care for Americans dying of terminal illness while possibly reducing costs.

As such, it is the proper subject of federal support.” 1979: The Health Care Financing Administration (HCFA) initiates demonstration programs at 26 hospices across the country to assess the cost effectiveness of hospice care and to help determine what a hospice is and what it should provide. 1980: The W.K. Kellogg Foundation awards a grant to the Joint Commission on Accreditation of Hospitals (JCAHO) to investigate the status of hospice and to develop standards for hospice accreditation. 1982: Congress includes a provision to create a Medicare hospice benefit in the Tax Equity and Fiscal Responsibility Act of 1982, with a 1986 sunset provision. 1984: JCAHO initiates hospice accreditation. 1986: The Medicare Hospice Benefit is made permanent by Congress and hospices are given a 10% increase in reimbursement rates. States are given the option of including hospice in their Medicaid programs. Hospice care is now available to terminally ill nursing home residents. 1989: The Government Accounting Office releases a study stating that only about 35% of eligible hospices are Medicare-certified.

There are several reasons listed, one of which is the low payment rates HCFA had established for hospices. 1989: Congress gives hospices their first increase (20%) in reimbursement since 1986 and ties future increases to the annual increase in the hospital market basket through a provision contained in the Omnibus Budget Reconciliation Act of 1989. 1991: The Commission on the Future Structure of Veterans Health Care (Mission Commission) releases a report recommending inclusion of hospice care in the veteran’s benefit package. 1992: Congress passes the Indian Health Care Improvement Act of 1992, calling for a hospice feasibility study. 1993: Hospice is included as a nationally guaranteed benefit under President Clinton’s health care reform proposal. Hospice is now an accepted part of the health care continuum. 1994: HCFA sends a memorandum alerting the regions of problems regarding questionable certifications and recertifications of terminal illnesses. This results in the first “focused medical review” for hospices and a wake-up call to the industry to improve its documentation and certification procedures or be denied payments.

1995: HCFA releases an expanded version of the Hospice Interpretive Guidelines, which provides much needed clarification of the Conditions of Participation (CoP). The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) Hospice Benefit is implemented June 1, 1995. It mirrors the Medicare Hospice Benefit in CoPs and reimbursement. 1995: The Office of Inspector General (OIG) announces the Operation Restore Trust (ORT), a special program to combat waste and abuse in Medicare and Medicaid in five targeted states—California, Florida, Illinois, New York, and Texas—would be expanded to include hospice. 1996: The Ninth U.S. Circuit Court of Appeals in San Francisco overrules a Washington State Law against physician-assisted suicide. The Second US Circuit Court of Appeals strikes down New York’s law against physician-assisted suicide. Both rulings are appealed to the US Supreme Court. 1996: Bills are introduced in the U.S. House of Representatives and the U.S. Senate to make technical changes and improvements to the Medicare Hospice Benefit. The hospice industry provides full support for both bills.

1996: Major grant-makers pour money into funding for research, program initiatives, public forums, and conferences to transform the culture of dying and improve care at the end of life. 1997: ORT is extended and expanded to target all 50 states and additional types of health care providers. 1997: The Balanced Budget Act of 1997 (BBA 97) includes hospice provisions that, among other things, restructure the hospice benefit periods and remove physician services from the core services requirement. BBA 97 also reinstates a hospice cost report and reduces hospice payment updates by market basket minus one percentage point. 1997: Congress passes legislation barring taxpayer dollars from financing physician-assisted suicide. The US Supreme Court rules that mentally competent terminally ill people do not have a constitutional right to physician-assisted suicide, leaving the issue up to the states. Oregon voters affirm the right to physician-assisted suicide by passing for the second time its “Death with Dignity Act.” 1997: The growing end-of-life movement focuses national attention on quality of life at the end of life as well as the need for increased public awareness and physician education.

The hospice philosophy and concept of care are central to models for palliative and end-of-life care. 1998: Hospices nationwide report rapidly declining average and median lengths of stay. The percentage of hospice non-cancer admissions decreases dramatically, reflecting the problems associated with determining a six-month prognosis for these patients. 1998: An ORT report on hospice states, “Overall, the Medicare hospice program seems to be working as intended.” The OIG reveals that hospice will not be included in the 1999 work plan. 1998: Care Beyond Cure: Physician Education in End-of-Life Care is released by the Annenberg Center for Health Sciences and the National Hospice Foundation. 1999: The U.S. Postal Service issues the Hospice Care commemorative stamp in February. 1999: The Health Care Financing Administration (HCFA) releases the Hospice Cost Report. Medicare-certified hospice programs must file cost data for each fiscal year on or after April 1, 1999. 1999: The Office of Inspector General (OIG) releases the Draft Compliance Program Guidelines for the Hospice Industry.

1999: The National Data Set Survey is initiated by NHPCO with the goal of creating standardized data collection nationwide. 2000: The National Hospice Foundation launches a four year public service campaign taking ads out to televisions and cable stations across the U.S.; one of these ads wins the prestigious ADDY Award. 2000: U.S. Senate holds two major hearings on end-of-life care that include discussions of barriers to access of hospice care under the Medicare hospice benefit. 2000: National hospice community calls for more consistent Medicare surveys 2000: The Duke Institute on Care at the End of Life is established. 2000: PBS series On Our Own Terms: Moyers on Dying in America is the focus of national education and engagement programs. 2000: Research from the Department of Health and Human Services, Office of the Assistant Secretary on Planning and Evaluation, shows statistically significant findings supporting the provision of hospice care for residents of skilled nursing facilities. 2001: The passage of the Benefits Improvement and Protection Act of 2000 brings a five percent increase in the Medicare hospice reimbursement rates.

2001: A Call for Change: Recommendations to Improve the Care of Children Living with Life-Threatening Conditions is released by the Children’s Project on Palliative/Hospice Services. 2001: The Health Care Financing Administration (HCFA) becomes the Centers for Medicare and Medicaid Services (CMS). 2002: The Department of Veterans Affairs launches program to increase veterans’ access to hospice and palliative services while providing educational opportunities for clinicians in veterans’ healthcare facilities. 2002: Rallying Points, an initiative of RWJF’s Last Acts campaign, begins a three-year initiative to improve care and caring near the end of life. 2002: Federal court upholds Oregon’s physician-assisted suicide law. 2003: National Hospice and Palliative Care Organization celebrates its 25th anniversary. 2003: A Clinical Guide to Supportive and Palliative Care for HIV/AIDS, is released by the U.S. Health Services Resource Administration at The White House Conference on Palliative Care and the HIV/AIDS Global Pandemic. 2003: The web-based Family Evaluation of Hospice Care Survey is launched.

2003: The hospice awareness ribbon is unveiled prior to November’s National Hospice Month. 2004: More than 1 million Americans with a life-limiting illness were served by the nation’s hospices in 2004, the first time the million-person mark has been crossed. 2004: The Clinical Practice Guidelines for Quality Palliative Care is published in May by the National Consensus Project, a consortium of palliative care and hospice organizations. 2004: Elisabeth Kubler-Ross, a pioneer in the field of death and dying, dies at the age of 78. 2004: Robert Wood Johnson Foundation makes generous grant to National Hospice and Palliative Care Organization to advance public understanding and awareness of end-of-life care: NHPCO’s Caring Connections is created. 2005: Caring Connections, NHPCO’s consumer engagement initiative launches the comprehensive “It’s About How You LIVE” national campaign. 2005: Robert Wood Johnson Foundation continues its support of NHPCO’s Caring Connections consumer engagement initiative with an additional $4.9 million grant.

2005: The Department of Veterans Affairs releases the report, VA Transforms End-of-Life Care for Veterans. 2005: National dialog on the importance of advance care planning increases as the case involving Teri Schiavo—who dies in March—escalates in the media and within public policy debates. 2005: The Diana, Princess of Wales Memorial Fund and the Franklin Mint make $3.35 million gift to promote better end-of-life care. 2005: The first national conference on access to hospice and palliative care is hosted by NHPCO in St. Louis. 2005: The American Heart Association and the American College of Cardiology release new guidelines about treating heart failure that includes recommendations that hospice care education be provided early in the course of an illness. 2005: The number of hospice provider organizations throughout the country tops 4,000 for the first time. 2006: Inaugural World Day is held on October 1 to focus global attention on hospice and palliative care; events are held in 70 countries.

2006: Quality Partners, a national, collaborative effort developed to build organizational excellence and improve hospice and palliative care delivery and outcomes is launched by NHPCO at the annual Management and Leadership Conference in New York City. 2006: The American Board of Medical Specialties (ABMS) recognizes hospice and palliative medicine as a medical specialty. 2006: U.S. hospice industry receives $13 Million Grant of Fujitsu Technology. 2006: A Guide to Supportive and Palliative Care for HIV/AIDS in Sub-Saharan Africa is released; the publication was funded by the U.S. Government through the HIV/AIDS Bureau, Health Resources and Services Administration, and NHPCO. 2006: Dame Cecily Saunders dies and a celebration of her life is held in Westminster Abbey on March 8; the U.S. hospice community issues a resolution honoring Dame Cecily. 2007: Research published in the Journal of Pain and Symptom Management reports that hospice patients live an average 29 days longer than similar patient that did not have hospice care.

2007: Findings of a major study out of Duke University published in the Journal of Pain and Symptom Management shows that hospice services save money for Medicare and bring quality care to patients and families. 2007: The National Quality Forum releases A National Framework for Palliative and Hospice Care Quality Measurement and Reporting. 2007: The Alliance for Care at the End of Life, a 501(c)4 organization is created to provide the hospice community with a more comprehensive, strategic voice on Capitol Hill. 2007: The Worldwide Palliative Care Alliance is formed to address global care needs at the end-of-life. 2008: The inaugural National Healthcare Decisions Day is held on April 16. 2008: The regulations (Conditions of Participation) for Medicare certified hospice providers issued by the Centers for Medicare and Medicaid Services were significantly revised for the first time since the original publication. 2008: Florence Wald, pioneer in the field of hospice care in the U.S., died peacefully at her home in Connecticut on Saturday, November 8. She was 91. 2008: NHPCO calls for increased access to palliative care in critical care settings.

2008: Certificate of Added Qualifications, or CAQ, in hospice and palliative care becomes available. 2008: NHPCO and its affiliate organizations (National Hospice Foundation, FHSSA, and The Alliance for Care at the End of Life) move into the National Center for Care at the End of Life in Alexandria, Virginia. 2009: The Accreditation Council for Graduate Medical Education, a private, non-profit organization responsible for the accreditation of post-MD medical training programs within the United States, adds hospice and palliative medicine to its list of accredited programs. 2009: The number of hospice volunteers continues to grow with a record 550,000 people serving as volunteers. 2009: The NHPCO Standards of Practice for Pediatric Palliative Care and Hospice along with the companion publication Facts and Figures on Pediatric Palliative and Hospice Care in America are released. 2009: Hospice leaders from the U.S. meet HRM Queen Elizabeth II at the Silver Jubilee Celebration for the U.K.-based Help the Hospices.

2009: Research published in the Archives of Internal Medicine suggests benefits of advance care planning discussions with physicians include lower costs and reduced utilization of aggressive care at the end of life. 2009: NHPCO's Caring Connections and Google Health partner to offer new way for people to access advance directives online. 2009: Quality Guidelines for Hospice and End-of-Life Care in Correctional Settings is published. 2010: NHPCO Standards of Practice for Pediatric Palliative Care and Hospice Receives American Academy of Pediatrics’ Affirmation of Value. 2010: We Honor Veterans, a pioneering campaign to help improve the care Veterans receive from hospice and palliative care providers, is launched by NHPCO in collaboration with the Department of Veterans Affairs. 2010: A provision in The Patient Protection and Affordable Care Act will require state Medicaid programs to allow children with a life-limiting illness to receive both hospice care and curative treatment. 2010: Research publishedin New England Journal of Medicine finds that patients with non-small-cell lung cancer may live longer with hospice and palliative care.

2011: NHPCO publishes report, Private Conversations and Public Discourse: The Importance of Consumer Engagement in End-of-Life Care. 2011: The Concurrent Care for Children: Implementation Toolkit is released by NHPCO and the District of Columbia Pediatric Palliative Care Collaboration. 2011: Campaign for the National Center for Care at the End of Life Launched by National Hospice Foundation. 2011: Ethical Marketing Practices position statement and commentary are released by NHPCO. 2011: The bicameral Wyden-Roberts HELP Hospice Act is introduced in Congress. The Concurrent Care for Children: Implementation Toolkit is released by NHPCO and the DC Pediatric Palliative Care Collaboration. 2012: LIVE—Without Pain, a new public awareness campaign from NHPCO’s Caring Connections, dispels myths about pain and empowers consumers. 2012: An innovative, online advocacy resource, the Legislative Action Center, is created online by the Hospice Action Network. More than 1.5 million people are reached through the six-part online video series, Basics of Hospice.

2013: Research from Mount Sinai’s Icahn School of Medicine demonstrates cost savings of hospice and NHPCO and Hospice Action Network work to take this research to legislators and the media. 2014: Forty years after the creation of Connecticut Hospice, NHPCO and its affiliates celebrate 40 years of hospice care in the US. 2014: FHSSA expands its mission and is re-launched as Global Partners in Care. Updated: 3/28/2016 Dame Cicely Saunders, founder of the modern hospice movement, dies | The BMJ Dame Cicely Saunders, founder of the modern hospice movement, dies Dame Cicely Saunders Founder of the modern hospice movement Cicely Mary Strode Saunders, medical director St Christopher’s Hospice 1967-85 (b Barnet, Hertfordshire, 22 June 1918; q St Thomas’ Hospital, London, 1957; OM, DBE, FRCP), died 14 July 2005.

Cicely Saunders founded the first modern hospice and, more than anybody else, was responsible for establishing the discipline and the culture of palliative care. She introduced effective pain management and insisted that dying people needed dignity, compassion, and respect, as well as rigorous scientific methodology in the testing of treatments. She abolished the prevailing ethic that patients should be cured, that those who could not be cured were a sign of failure, and that it was acceptable and even desirable to lie to them about their prognosis. She put paid to the notion that dying people should wait until their painkillers had worn off before they received another dose, and scotched the notion that the risk of opiate addiction was an issue in their pain management. Cicely Saunders became, and perhaps always was, a grande dame and natural leader, and established a reputation in the national consciousness almost on a par with that of Florence Nightingale. She became a folk hero after the journalist Victor Zorza and his wife wrote a persuasive and moving account of their daughter’s death in a hospice. In 1967 she founded St Christopher’s Hospice in south west London. It is now one of many but is still the leader in the field.

It was her personal achievement and has been imitated all over the world. St Christopher’s was the first modern hospice, although there were a number of homes in existence for the dying, most of which were run by religious orders. She raised the funds for the hospice and contributed some of her own money. Saunders introduced the idea of "total pain," which included the physical, emotional, social, and spiritual dimensions of distress. She regarded each person, whether patient or staff, as an individual to the end. A good listener, she paid systematic attention to patient narratives. She did away with "visiting hours," which had been an excuse for having non-visiting hours. One St Christopher’s patient, transferred from another hospital, said, "They used to see how long I could go without an injection. I used to be pouring with sweat because of the pain. I couldn’t speak to anyone and I was having crying fits. I think I’ve only cried once since I’ve been here . . . The biggest difference is feeling so calm.

I don’t get worked up or upset." Cicely Mary Strode Saunders was born in Barnet, Hertfordshire, in 1918, the eldest of three children, into a well-off but unhappy family. Her domineering father was an estate agent, and they lived in some comfort in a large house with lawns and tennis courts. Her mother was cold and withdrawn. She was given into the care of her unmarried Aunt Daisy when she was one, only to be snatched back again through jealousy of Daisy’s influence. She was sent to Roedean School when she was 10. Taller than the other girls, she felt she never fitted in, which, she said, gave her a feeling for people who were outsiders. She also suffered from a painful and slightly crooked spine, and was made to lie flat on the floor for 40 minutes a day. Her father disapproved of her desire to be a nurse, and so instead she went to St Anne’s College, Oxford, where she read politics, philosophy, and economics, intending to become a secretary to an MP.

After the outbreak of the second world war she abandoned her course and defied her parents’ advice, enrolling as a student nurse at St Thomas’ Hospital in 1944, where she was recognised as a potential high flyer. However, her back was still painful, and she was advised her to quit nursing. After returning to Oxford for a year she gained a "war degree" and qualified as a social worker, or what was then called a lady almoner, in 1947. Saunders was originally an agnostic, but, while on holiday in Cornwall with some Christian friends, she discovered she really believed in God. It was, she said, "as if a switch had flipped." A year later, during her work as an almoner, at Archway Hospital, she cared for a dying 40 year old Polish Jewish émigré called David Tasma. He felt that his life had been wasted. He had no relatives in England, and only a handful of friends. In a brief and intense relationship—which probably amounted to a spiritual love affair—they discussed the idea that she might found a home for dying people to find peace in their final days.

He left her £500, then a substantial sum, and the prophecy "I’ll be a window in your home." There is now a window dedicated to him at St Christopher’s; it is plain and has a view of the car park. David Tasma’s death coincided with the death of Cicely Saunders’ father and that of a close friend, and she fell into a state of "pathological grief." She felt that, at last, she knew what God had called her to do, which was to build a home for dying people, where scientific knowledge should be combined with care and love. She supplemented her almoner work with being a volunteer sister at St Luke’s Hospital in north London. Saunders sought closer contact with patients and asked her orthopaedic surgeon if she might work as a night nurse, which would put less strain on her back, since most of the lifting work is done by day staff. His opinion was that people wouldn’t listen to her as a nurse, that doctors desert the dying, and that she could best help dying patients by becoming a doctor. She was accepted as a medical student at St Thomas’ Hospital aged 33. Her father funded her studies.

Her fellow students made little effort to include her because she was much older. However, she impressed her teachers with her emotional maturity; one, Alex Paton, recalls her spending her free time reading to a patient who had suddenly become blind. In 1958, shortly after she qualified, she wrote an article arguing for a new approach to the end of life. In it she said, "It appears that many patients feel deserted by their doctors at the end. Ideally the doctor should remain the centre of a team who work together to relieve where they cannot heal, to keep the patient’s own struggle within his compass and to bring hope and consolation to the end." After qualifying as a doctor, she obtained a research scholarship at St Mary’s Hospital, Paddington, where she studied pain management in the incurably ill, and at the same time worked at St Joseph’s, a hospice for the dying poor in Bayswater, run by nuns. Here she used her medical expertise and research findings to help the nuns improve their standard of care. She developed record-keeping methods on 1100 patients, introducing a punch-card system.

Notably, she wrote six articles on care of the dying in Nursing Times in 1959; they were favourably reviewed in the Lancet. At St Joseph’s she introduced the system of pain control she had developed at St Luke’s. It was a hardheaded approach ("constant pain needs constant control"), whereby patients were given regular relief and not forced to wait until their pain returned and they cried out. This greatly reduced their fear and anxiety and this, in turn, reduced pain and their need for pain relief. She said that there was no such thing as intractable pain, though she had met intractable doctors. She argued that if physical pain was alleviated, then mental pain was also relieved. She distinguished between mild, medium, and severe pain, each of which was to be treated differently. She also used medicines to relieve other problems of the dying, including bedsores, nausea, depression, constipation, and breathlessness. In 1960, at St Joseph’s, she met Antoni Michniewicz, the second of the three Polish men who influenced her life. Again, they had a close spiritual relationship.

At the same time she devoted herself to the cause she had chosen, which was to found a hospice, a remarkable thing for a newly qualified doctor to do. She read widely on death and dying, and was impressed by the view of Elisabeth Kübler-Ross (obituary BMJ 2004;329:627) that there were five psychological stages of dying: anger, denial, bargaining, depression, and acceptance. In late 1959 she had drawn up a 10 page proposal that she circulated to friends. It outlined the structure and organisation of a 60 bed hospice. She named it after St Christopher, patron saint of travellers, and initially wanted it to be a Church of England hospice, but several grant-giving organisations required her to make it open to people of all faiths, so she modified the plan; the hospice was to be "a religious foundation of an open character." She drew up detailed plans and costed every stage of the process. She met her architect in 1959, and the St Christopher’s charity was registered in 1961. Her brother found a location in 1963 at Sydenham.

Between 1961 and 1964 she raised £330 000. By 1966 the estimated cost was £400 000 and a year later it stood at £480 000. All this time she was working at St Joseph’s. In 1963 she went on a "voyage of discovery" to the United States, which was ahead of the United Kingdom in pain research. Building work started in 1965—the year she was awarded an OBE—and money was still not coming in fast enough: at times the builder wasn’t paid on time. Cicely Saunders had tremendous support from a wide spectrum of society: local children helped prepare the garden, and fire officers hung the curtains. The hospice contained 54 inpatient beds. An article published shortly after opening said that the hospice "will try to fill the gap that exists in both research and teaching." There were plans for those who needed respite care, and for a home care service. The first patient was admitted in 1967. Princess Alexandra performed the opening ceremony and still visits every year, shortly before Christmas.

The hospice soon extended its activities to research, and added a study centre. By 1970 the NHS contributed two-thirds of the running costs, and NHS doctors undertook part of their specialist training there. In 1963, three years after the death of Antoni Michniewicz, Cicely Saunders met another Polish man, who was to become her husband. Marian Bohusz-Szyszko was an émigré painter with a degree in fine art. She admired a sombre blue crucifixion he showed at a London gallery, wrote to him, and later became his patron; a substantial amount of his work is hung at the hospice. He had a long-estranged wife in Poland, whom he supported, and he was a devout Catholic. In 1969, he and Cicely and another couple bought a house in Sydenham, which they shared; they called it their kibbutz and it was a lasting domestic arrangement. Marian’s wife died in 1975, and in 1980 he married Cicely; she was 61 and he was 79. That same year she was made a dame.

Marian died in 1995, spending his last days at St Christopher’s. Cicely Saunders stepped down as medical director of St Christopher’s in 1985, remaining as chairman. She received awards from all over the world. She was strongly against euthanasia, partly because she was a committed Christian, and also because she argued that effective pain control is always possible and that euthanasia is therefore not needed. She did acknowledge, however, that both sides in the euthanasia debate were against pointless pain and impersonal indignity. She developed breast cancer but continued to work, even from her deathbed. She died at St Christopher’s.[Caroline Richmond] About Hospice and Palliative Care - History of Hospice - Nebraska Hospice and Palliative Care Association About Hospice and Palliative Care - History of Hospice History of Hospice The term "hospice" was used in medieval Europe for a place where travelers could find shelter. Dame Cecily Saunders founded the modern hospice movement in London, England, in the 1960s with the establishment of St.

Christopher’s Hospice, a place that sought to meet the pain, comfort and closure needs of the dying at a time when the medical establishment virtually ignored death. The first hospice in the United States was established in 1971 in New Haven, Conn., as a way to provide similar support for dying individuals in their own homes. The hospice movement reached a major milestone in 1983 when Congress made hospice a benefit of the Medicare program. Today, more than 4,000 hospice programs serve over one third of Americans in their last weeks and months of life each year. Brief history of the hospice movement - Farleigh Hospice Brief history of the hospice movement Brief history of the hospice movement The hospice movement as we know it today was founded in Britain by Dame Cicely Saunders. In the 1950s Cicely Saunders (who later became Dame Commander of the British Empire because of her pioneering work) began to develop the techniques of pain control which she had first observed when a volunteer at Saint Luke’s Hospital.

It is little known that Dame Cicely is qualified in three different professions; she first became a registered nurse; then a certified social worker, and finally, she became a qualified doctor when she recognised it was the only way she would be able to realise her ambition to help those in pain in the way she wished. At Saint Luke’s Hospital the practice had been to give tablets regularly to stop pain, rather than wait until the person complained of discomfort. This system operated very well and provided the basis on which Dame Cicely continued her work. She originally conceived her idea of opening a home, especially for those with incurable diseases, in 1947. Her aim was to establish a place dedicated to research and patients. These extra components make the modern hospice movement different from its forerunners and this is why Dame Cicely is acknowledged as the founder of the modern hospice movement. Saint Christopher’s in Sydenham in South East London, which is Dame Cicely’s ‘own’ hospice, opened in 1967 and had largely been inspired by David Tasma, one of her early patients.

Through their special relationship, as he lay ill, she gained a valuable insight into how the dying could be helped and cared for, not only physically but also emotionally and spiritually. David left the first £500 she needed to launch Saint Christopher’s. “I’ll be a window in your home”, he had said. Today a vast window at the front of the hospice is called “The David Window”. Since the opening of Saint Christopher’s more than 220 similar units have been set up throughout the United Kingdom. Many of these have specialist palliative care teams which go into patients’ homes working with other community healthcare professionals. Many also have day care facilities. Although hospices have cared primarily for people who have advanced cancer, many are now including people with other life-limiting illnesses, such as Motor Neurone Disease and AIDS. Many people from all around the world visited hospices in Britain and saw what was being done to help those in need. Following Dame Cicely’s example, they returned to their own countries, determined to give similar help to their own people. The philosophy of hospice care, with its special approach to helping with the problems faced by the patients and their families, was not always easily understood by people who had not experienced it.

It was not easy to explain, and even harder to gain the co-operation of doctors and nurses in countries where the concept was unknown. It was also very difficult, sometimes, to gain the agreement of governments to allow the establishment of hospices and to grant funds for development. Farleigh Hospice opened in 1982 and was based upon the principles set our by Dame Cicely Saunders. Since then, like the much of the hospice movement, Farleigh Hospice has grown to care for patients and relatives from much earlier on in their conditions with the focus being on life rather than death. Our huge range of services support peope from diagnosis and care for patients and their families as a whole; physically, socially, emotionally and spiritually. St Christopher's | Dame Cicely Saunders - St Christopher's St Christopher's Her life and work Dame Cicely Saunders Born 22 June 1918 in Barnet, Hertfordshire, Dame Cicely trained as a nurse, a medical social worker and finally as a physician. Involved with the care of patients with terminal illness since1948, she lectured widely on this subject, wrote many articles and contributed to numerous books.

Dame Cicely founded St Christopher’s Hospice in 1967 as the first hospice linking expert pain and symptom control, compassionate care, teaching and clinical research. St Christopher’s has been a pioneer in the field of palliative medicine, which is now established worldwide. Through her single-minded vision, and the clinical practice and dissemination of her work through St Christopher’s teaching and outreach, Dame Cicely revolutionised the way in which society cares for the ill, the dying and the bereaved. Her vision to establish her own home for the dying was underpinned by her religious faith. She had initially thought of creating an Anglican religious community but broadened her vision so that St Christopher’s became a place that welcomed staff and patients of any faith or none. However, Cicely’s strong Christian faith was a fundamental factor in her commitment to the dying and remained an anchor throughout her life. Dame Cicely is recognised as the founder of the modern hospice movement and received many honours and awards for her work. She held more than 25 honorary degrees, from the UK and overseas.

Awards included the British Medical Association Gold Medal for services to medicine, the Templeton Prize for Progress in Religion, the Onassis Prize for Services to Humanity, The Raoul Wallenberg Humanitarian Award and the Franklin D. Roosevelt Four Freedoms for Worship Medal. Dame Cicely was made a Dame of the British Empire in 1979 and awarded the Order of Merit in 1989. Dame Cicely Saunders recognised the inadequacy of the care of the dying that was offered in hospitals. So often, patients and families were told that “there was nothing more that could be done” a statement that Dame Cicely refused to accept. Throughout her time at St Christopher’s her watchword was”there is so much more to be done.” Dame Cicely Saunders Pioneering research on the use of morphine as an effective drug for pain control was carried out at St Christopher’s, along with other detailed studies of new approaches to symptom control. Dame Cicely also understood that a dying person is more than a patient with symptoms to be controlled. She became convinced of the paramount importance of combining excellent medical and nursing care with “holistic” support that recognised practical, emotional, social, and spiritual need.

She saw the dying person and the family as the unit of care and developed bereavement services at St Christopher’s Hospice to extend support beyond the death of the patient. In 1969 Dame Cicely pioneered the first home care team taking St Christopher’s care and philosophy out into the community. In 2001 St Christopher’s Hospice received the Conrad N Hilton Humanitarian Prize – the world’s largest humanitarian award – of one million dollars for the work originated by Dame Cicely through the Hospice. Dame Cicely Saunders died peacefully on Thursday 14 July 2005 at St Christopher’s Hospice in south London, the world-famous hospice that she founded in the 1960s, and the birthplace of the modern hospice movement. A Service of Thanksgiving for the life of Dame Cicely Saunders was held at Westminster Abbey on 8 March 2006. Barbara Monroe, Chief Executive of St Christopher’s Hospice, said, “Dame Cicely’s vision and work has transformed the care of the dying and the practice of medicine in the UK and throughout the world. She is an inspiration to us all.

“We had been caring for Dame Cicely at St Christopher’s Hospice as a patient for some time. We will miss her very much. Her influence will carry on around the world as we work together in hospice and palliative care to support dying people and close to them. “It is a privilege to share in Dame Cicely’s vision and her work here at St Christopher’s. We are dedicated to improving care for dying people everywhere.” BIOGRAPHICAL NOTES: Dame Cicely was educated at Roedean (1932-37), St. Anne”s College Oxford (1938 – 1939 and 1944-45). She trained as a nurse at St Thomas’s Hospital Nightingale School of Nursing from 1940-44; qualified AIMSW (Medical Social Worker) in 1947 and trained as a doctor at St Thomas’s Hospital Medical School (1951-57) qualifying MB, BS with Honours in surgery. Contact our Librarian Denise Brady at d.brady@stchristophers.org.uk or visit Library or Bookshop for further information.

Extensively published from 1959 onwards, a full list of publications and access to archive material may be requested from Professor David Clark, University of Lancaster (email) d.clark@lancaster.ac.uk Find out more downloads, contacts and useful links For more information, please contact the Communications Manager at St Christopher’s Hospice press office 020 8768 4585 The hospice movement - Wigan & Leigh Hospice The hospice movement Share | The hospice movement Fifty years ago there were no Hospices in the UK providing specialist care for those at the end of their lives. The Hospice movement is one of the UK's great success stories. From just one voluntary Hospice established in 1967 the Hospice movement has made rapid advances, both within the UK and around the world, changing forever the way people are treated when faced with a life-limiting illness. A primary service of a Hospice is to provide 'palliative care' - that is care for people whose illness is no longer curable, which enables them to achieve the best possible quality of life. A Hospice also provides support for carers and family members.

The modern Hospice movement The inspiration for the modern Hospice came from Dame Cicely Saunders. She had started work as a volunteer nurse in 1948 and, over the next decade, trained as a doctor to understand the issues surrounding care of the dying. Dame Cicely identified the need for a place specifically to provide end of life care through a friendship she had struck up with a patient under her care. This patient spent the last two months of his life on a busy surgical ward, simply because there was nowhere else he could go. Dame Cecily Mary Saunders "You matter because you are you and you matter until the last moment of your life. We will do all we can, not only to help you die peacefully but to live until you die." - Dame Cicely Saunders, founder of the UK hospice movement Dame Cicely pioneered and oversaw the opening of St Christopher's Hospice in London in 1967 created as a medical, teaching and research facility dedicated to the physical, emotional and spiritual care of the dying. The growth of modern Hospices Hospice care has grown into a worldwide movement that has radically changed the way in which we approach death and dying.

In hospices multi-disciplinary teams strive to offer dignity, peace and calm at the end of life. Hospices have transitioned from places of 'generalist' care to organisations which provide truly specialist end-of-life care and a range of services which enhance the lives of patients, carers and families. Research into pain management and symptom control has driven the belief that palliative medicine is an important part of the 'total care' of a patient. The hospice care sector supports at least 120,000 people with terminal and life-limiting conditions each year. This increases to around 360,000 people when their family members are included. Hospice Movement - Term Paper Hospice Movement The Hospice Movement What is a hospice? A hospice is a place where people who are fatally ill can find care during their illness and then return home. The word hospice comes from the Latin word “hospes”, a word referring both to guests and hosts. Cicely Saunders She was a British registered nurse who pursued a career in medical social work due to chronic health problems.

She fell in love with a dying patient (David Tasma, a Polish refugee), this helped her solidify her ideas that terminally ill patients needed compassionate care to help address their fears and concerns as well as comfort for physical symptoms. One of her most important quotes is: "You matter because you are you, and you matter to the last moment of your life." After the refugee's death she volunteered at St Luke's Home for the Dying Poor where she was told that she could best influence the treatment of a terminally ill person as a physician. She then entered medical school and achieved her degree in 1957. Saunders believed that it is more important to focus on the patient rather than on the disease and introduced the term “total pain”, which included the psychological, spiritual and the physical aspects. She also believed that the needs of the patient's family should not be ignored. She spread her philosophy internationally in a series of tours of the United States that began in 1963. In 1967, Cicely Saunders and her colleagues opened St. Christopher’s Hospice, the world’s first modern hospice.

Cicely Saunders died of cancer at the age of 87 on the 14th of July in 2005, at St. Christopher's Hospice, the hospice she herself had founded. The modern hospice movement The modern hospice movement emerged in the late 1960s in England, when Cicely Saunders opened the first hospice (St. Christopher's Hospice) in 1967. The hospice movement was the answer to a society... History of Hospice - Hinds Hospice Hinds Hospice Employee Testimonials History of Hospice The word "hospice" first began being used in the mid-1800s to describe caring for dying patients by Mrs. Jeanne Garnier, the Founder of the Dames de Calaire in Lyon France. The Irish Sisters of Charity adopted it when they opened Our Lady's Hospice in Dublin, Ireland in 1879 and then again when they opened St. Joseph's Hospice in Hackney, London, England in 1905. Hospice did not become more widely known until Dame Cicely Saunders founded St. Christopher's House in 1967 ( ) .

Dame Cicely had been a nurse, but was currently working as a medical social worker when she came upon a patient by the name of David Tasma in 1948. David was suffering from inoperable cancer and together, they discussed her hopes for one day opening up a place that was more of a home environment to care for the terminally ill that did a better job of focusing on pain management and preparing the patient for death. When David passed away, he left her and told her, "I will be a window in your home." This was all the inspiration she needed to open St. Christopher's Hospice and since then, her ideals have been adopted by those all over the world and she is known as the founder of the modern hospice movement. Two years after the opening of St. Christopher's Hospice in England, Dr. Elisabeth Kubler-Ross wrote a book she based on over 500 interviews with dying patients. On Death and Dying became a best seller and gave people a first hand insight into the emotions and stages that people face when they are terminally ill. In her book, Dr. Kubler-Ross pleaded for better home care as opposed to an institutional or hospital setting.

She argued that patients should have a choice when it came to their healthcare and promoted their ability to participate as much as possible in the decisions that affected them. Also inspired by Dame Saunders' ideals, students at Yale University in New Haven, Connecticut invited her to speak and were so inspired, that they created and launched the United States' hospice movement. In 1974, a Hospice nurse in Connecticut and an accompanying volunteer made their first Hospice Home Care visit to a hospice patient in their own home. In 1981, Nancy Hinds in Fresno, California began caring for terminally ill patients in her own home. This inpatient hospice home allowed patients a place to die with dignity in a home setting when their family or caregivers were not able to care for them in their own homes. In 1986, Congress made permanent the Medicare Hospice Benefit and the various States were allowed to decide whether they wanted to include hospice in their Medicaid programs. Estimates show that there are approximately 3,200 different hospice programs in the United States, Puerto Rico and Guam. This includes both inpatient (hospice home) programs and outpatient (in the patient's own home) programs.

Hospice Pioneers, Hospice Movement Information Volunteers Hospice Pioneers Hospice is a particular type of care and even more than that it is a care philosophy that focuses on the palliation of a terminal ill individual’s symptoms. The symptoms can include anything from emotional, social, physical and social symptoms and they can vary from patient to patient. The physical and philosophical concept has started evolving in the 11th century. Back then, hospices were the places where the sick, the wounded and the dying patients were gathered so that specialists could take care of them at the same time. Moreover, a hospice in those times would also accommodate travelers and pilgrims. The modern concept of hospice includes palliative care for the individuals who had been diagnosed with incurable condition and it is commonly given in institutions such as hospitals or nursing homes. Some patients prefer being provided with this type of care at home as they would rather like to die in their own homes. The modern concept of hospice evolved in the 17th century but most of the principles on which modern hospice services operate have been founded in the 1959s by Dame Cicely Saunders.

Initially, the movement was received with a significant resistance, yet the concept managed to expand quite quickly in the United Kingdom, then in the US and afterwards in other places of the world. The pioneer of the hospice movement, Dame Cicely Saunders was a British nurse who was herself chronically ill, suffering from heart problems. Her health situation forced her to follow a career in medical social work and her principles are thought to have evolved during the special relationship that she had developed with a terminally ill Polish patient. She then discovered that terminally ill individuals need more compassionate care to help address their fears and that they also need palliative comfort for various physical symptoms. Following the death of the Polish refugee, Saunders began working for St Luke’s Home for the Dying Poor where she had been told that the best way to influence the treatment of a terminally ill patient was as a physician. She then went to medical school which she graduated in 1957 and remained working as a physician for the same care institution. Her main ideas were based on the fact that treatment should rather be emphasized on the patient and not so much on the disease. She was the one who had introduced the notion of total pain which included psychological, emotional and spiritual pain as well as physical pain.

She experimented with various opioids to control the physical pain but she recognized the need of the patient’s family at the same time. In the late 1960s, another significant discovery was made in the field by Dr. Kubler-Ross, the author of the five stages of grief model. NAHF :: History of the Hospice Movement History of the Hospice Movement You are: Home > What Is A Hospice? > History of the Hospice Movement History of the Hospice Movement The word 'hospice' was first used from the 4th century when Christian orders welcomed travellers, the sick and those in many kinds of need. It was first applied to the care of dying patients by Mme Jeanne Garnier who founded the Dames de Calaire in Lyon, France, in 1842. The name was next introduced by the Irish Sisters of Charity when they opened Our Lady's Hospice in Dublin in 1879 and St Joseph's Hospice in Hackney, London(1905).

Dame Cicely Saunders' experiences while working at St Joseph's and at St Luke's Hospital (Home for the Dying Poor founded in 1893) led to the founding by her of St Christopher's Hospice in 1967. Two national charitable organisations, Marie Curie Cancer Care and The Sue Ryder Foundation have also played an important role in providing specialised care for dying people and their families. The 11 Marie Curie Homes were developed in the 1950s and the Sue Ryder Homes began to emerge in the 1970s. The growth pattern of hospices in recent years has been considerable. In the first few years after the opening of St Christopher's development was mainly in the independent, charitable sector. In the early 1970s the National Society for Cancer Relief (now known as Macmillan Cancer Relief) began a programme whereby capital grants were given to units built within NHS hospital grounds with health authorities taking over responsibility for their running costs. Hospices and palliative care have developed in different ways, appropriate to the needs of patient and family - inpatient care, home care, day care and hospital services.

The different categories of patient care provided by hospices and palliative care centres are as follows: Independent or Voluntary Hospices - these units are registered charities financed mainly by charitable income. They have firm links in policy and practice with the National Health Service but receive only partial funding from PCTs. In addition to inpatient care most hospices provide home care, day services and bereavement support. Some buildings are purpose built, while others may have been established in a converted building. Units range in size from 2 to 63 beds. Marie Curie Centres are administered by the national charity, Marie Curie Cancer Care. In addition to 11 homes there are 6000 part-time Marie Curie Nurses who nurse patients in their own homes. Sue Ryder Homes administered by the national charity, the Sue Ryder Foundation, provide palliative care for patients with cancer in all of their homes, and several have visiting nurses who attend patients in their own homes, both before admission and after returning home. Macmillan Cancer Care Units. Macmillan Cancer Relief has funded and built many inpatient and day patient units, mostly on hospital sites and now being funded and operated by the National Health Service.

Macmillan has also funded, or part funded, several units operated by the voluntary sector. Palliative Care Wards/Units in NHS Hospitals. Some hospitals have designated units or wards where patients benefit from the principles and practice of hospice care. Some Care Homes practice the principles of Hospice care. © NAHF 2009

Question: Who, in 1960, founded the Hospice movement in Britain?
Answer: Cicely Saunders